Written by Dr Julian De Silva
A droopy brow is characterized by the eyebrow sagging downwards which can create more fullness in the upper eyelid and a more tired appearance. With time compensatory facial expression may result in the use of the forehead muscles to lift the eyebrow resulting in deep forehead lines. A brow lift is a procedure that lifts the eyebrow restoring it to its natural position, creating a natural rejuvenation.
With respect to facial anatomy, there are measurements and positions of the eyebrows that are regarded as normal. In women, a youthful feminine brow is considered to be at the level or above the upper boney margin and has a higher arch towards the outside tail of the brow.
With facial ageing, there can be the descent of the brow as a combination of gravity and facial expressions that results in a lower and flatter brow. In men, the eyebrow position is youth is lower than in women with a flatter shape.
Although we know these are common positions of the eyebrows, the natural position of the brow is very variable and any brow lift procedures need to be customized for an individual based on their unique changes with facial ageing.
In the past brow surgery was over-used as a substantial proportion of people naturally have low eyebrows, including may famous actors and actresses, George Clooney, Tom Cruise, Nicole Kidman and Grace Kelly. In people who always had low eyebrows, it is unwise to have brow lift surgery as this procedure can change a person’s appearance by giving them a surprised look.
Grace Kelly had relatively low eyebrows in her youth. Dr De Silva would advise against forehead or brow lift surgery in patients with naturally occurring low eyebrows and the surgery can change one’s appearance.
Endoscopic brow lift surgery utilizes small hidden-incisions that are hidden within the hair and the use of a tiny camera to elevate the forehead with keyhole surgery.
The camera enables the surgeon to see the anatomy underlying the forehead with specialist equipment; the technique is advanced and requires skill to lift the brow effectively and long-term.
Dr De Silva uses a specialized US technique and 3D telescopic imaging to enable the smallest incisions and fastest possible recovery after forehead lifting.
The traditional techniques to lift the forehead and brow required a large incision in the forehead (Direct brow lift) or very large incisions in the hairline (Coronal brow lift from one ear to the other ear) although these techniques were effective in lifting the forehead, they left noticeable scarring and were associated with greater downtime and recovery period.
To complete Endoscopic surgery, the latest in state-of-the-art technology is required to give a 3D- Telescopic image of the anatomy through a tiny skin incision.
Dr De Silva uses a myriad of surgical techniques taken from his experience in London, Los Angeles and New York. For the forehead, eyebrows and upper eyelids the removal the exact amount of soft tissues and lifting is required to ensure harmony between the two eyes and natural looking result.
Dr De Silva is known for natural looking results and brow and forehead lifting techniques require complete customization to the individual patient.
Dr De Silva uses only state-of-the-art technology to give patients the best possible results, including the latest in high technology 3D telescopic imaging and surgical equipment.
Dr De Silva uses hidden incision techniques for most patients that result in fast recovery, less downtime and natural looking results. Often brow lifting is used in conjunction with other facial procedures to improve the result:
The images below are taken from Dr De Silva’s book on Facial Cosmetic & Plastic Surgery, showing different techniques for brow and forehead lifting. Older and more traditional brow lifting techniques required large scars and long recovery, shown in the below image as the coronal brow lift and direct brow lift. Dr De Silva favours the endoscopic technique that utilises tiny incisions hidden in your hair line, these pocket incisions are used to lift the eyebrow resulting in hidden scars and faster healing.
The recovery from forehead lifting is dependent on the technique used. Traditional techniques such as a coronal brow lift had a long recovery period. Dr De Silva utilises modern techniques such as Telescopic camera lifting where the recovery is between 1-2 weeks.
Most patients have minimal discomfort after the procedure that settles within 24-48 hours with oral analgesia. The recovery period can be reduced with the use of ice packs (bag of peas in a zipper container) every hour while awake for the first three days, resulting in a reduction in the amount of postoperative swelling.
All patients will have some numbness in the forehead after the procedure, by using the hidden incision endoscopic techniques this is reduced, and improves after around 6-weeks and may be accompanied by some temporary itchiness.
Usually, the patient may return to normal non-strenuous activities 1 week after the procedure and by 2 weeks the forehead and eyelids are on average 90% improved. Initially, the eyebrows may be higher after surgery and then the eyebrows lower to their normal height, the final result is between 6-12months after surgery.
Most patients that develop a droopy brow will notice these changes from the 30s onwards. However drooping of the eyebrow and forehead results from a combination of facial ageing and genetics, and in some people, a droopy eyebrow may occur earlier in your 20s as a consequence of your genetics and facial anatomy.
It would be important to evaluate the appearance of your eyes to exclude other causes of upper eyelid fullness including ptosis (droopy eyelid), facial nerve weakness or other congenital conditions that require a specialist assessment and treatment.
Age is not a limiting factor to have a forehead lift, as long as an assessment has been completed and the forehead lift is the optimal procedure.
The natural shape and position of the male brow are markedly different from the female brow. A man’s brow is commonly positioned lower than the female brow, at or even slightly below the orbital rim.
The male brow may or may not be arched laterally, and is commonly relatively flat. Each man needs to be independently evaluated for their facial changes to ensure a natural-looking rejuvenation.
Conservative lifting is required to avoid over lifting the male brow which can change a man’s appearance, sometimes seen in actors who look to have a changed appearance following plastic surgery.
George Clooney brow position demonstrates the marked anatomical difference compared to a female eyebrow. The brow is low with marked fullness in the upper eyelid and relatively flat in shape along its length from the nose towards the ear. Dr De Silva would advise conservative surgery wish such anatomy to enable a natural rejuvenation.
Men have other considerations such as loss of hair that are of key importance in procedure planning with a hidden incision. Endoscopic forehead lifting has a role in specific patients, other techniques such as trans-blepharoplasty brow lifting (brow lift through a blepharoplasty incision) and direct brow lifting have a role in specific patients.
The type of anaesthesia is determined by the exact type of brow lift. Dr De Silva most commonly uses a modification of the endoscopic brow lift surgery which is routinely performed under local anaesthesia with sedation (oral or intravenous), also called MAC (Monitored anaesthesia care ) or “twilight anaesthesia” or general anaesthesia.
There can be a number of reasons for eyebrow asymmetry, which can include variability of the underlying bone architecture, variability in eyelid position including the exclusion of ptosis (droopy eyelid), depending on the cause there are different treatment strategies.
Symmetry can be improved with a brow lifting procedure, realistic expectations are an improvement as perfect symmetry can be difficult to obtain as the underlying anatomy may differ between the two sides.
Renowned expert in Facial Cosmetic and Plastic Surgery. Signature techniques in Blepharoplasty, Rhinoplasty and Facelift surgery. Expert in revision surgery and in natural looking results
